Technology is evolving and, eventually, otolaryngologists might be able to determine which tumors require immediate surgery. “Until that day comes and until we have more concrete evidence…. it’s incumbent upon the surgeon to treat this disease accordingly,” said Dr. Tufano.

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Dr. Shaha said that a plan developed through meetings between the surgeon, endocrinologist, and the patient is crucial, so that patients are not lost to follow-up. “The more operations that we do, the more complications we are going to cause, more anxiety,” he said. “What we need is an understanding between the surgeon, the endocrinologist, and the patient himself, that we have a strategy. The problems come when there’s a dichotomy of opinion between the surgeon and the endocrinologist. And the endocrinologist says, ‘Yes, they have cancer, go in and have surgery.’ The surgeon doesn’t want to operate. And what does the endocrinologist do? Send the patient somewhere else…. Let the treatment not be worse than the disease.”

BAHA v. Unilateral Devices

In another “debate” during the session, Jack Wazen, MD, director of research for the Ear Research Foundation at the Silverstein Institute in Sarasota, Fla., discussed bone-anchored hearing devices, and Daniel Coelho, MD, assistant professor of otology, neurotology, and skull base surgery at Virginia Commonwealth University in Richmond, talked about unilateral cochlear implants.

Dr. Wazen said that research has shown that the newer, single-incision approach for implant bone-anchored hearing aids (BAHA) is a safer approach. “We’ve confirmed that the single incision has statistically significantly less risk of complications than the dermatome or the other earlier procedures,” he added.

With the DermaLock system, the abutment is covered with hydroxyapatite, with the intention of soft tissue adhering to it and creating a better seal, making for less soft-tissue inflammation and fewer complications. This is now FDA-approved, and the procedure takes approximately 10 minutes. Other systems are the Sophono, without a skin-penetrating abutment; the SoundBite Hearing System, which uses a wireless microphone behind the ear and a device that transmits through the teeth; and the Attract System, which has a magnetic system and no skin-penetrating abutment.

Dr. Coelho described the benefits of unilateral cochlear implants, which are not yet FDA-approved. Since they don’t have to route sound through the normal-hearing ear, they give patients two sides with hearing, rather than just one. The benefits of bilateral hearing, he said, are well borne out in studies, with better ear-specific hearing results when compared with BAHA and contralateral routing of offside signals devices, particularly with respect to sound localization and hearing amid noise.